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Outcomes of Abdominal Organ Transplantation Using Custodial HTK Preservation Solution

Outcomes of Abdominal Organ Transplantation Using Custodial HTK Preservation Solution. David C. Mulligan, MD, FACS Chair, Transplant, Hepatobiliary & Pancreatic Surgery Professor of Surgery, Mayo Clinic School of Medicine Mayo Clinic Arizona. Mayo Clinic Largest Transplant Entity in U.S.

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Outcomes of Abdominal Organ Transplantation Using Custodial HTK Preservation Solution

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  1. Outcomes of Abdominal Organ Transplantation Using Custodial HTK Preservation Solution David C. Mulligan, MD, FACS Chair, Transplant, Hepatobiliary & Pancreatic Surgery Professor of Surgery, Mayo Clinic School of Medicine Mayo Clinic Arizona

  2. Mayo ClinicLargest Transplant Entity in U.S. 1469 Total Transplants in 2006 717 446 306

  3. Mayo Clinic Data 2007

  4. MCA Abdominal Organ Transplant HistoryThen and Now • Liver Transplant Program • Deceased Donor Liver Transplantation (1999) • 2007 – 33rd out of 127 programs in US • Living Donor Liver Program (2001) – 1st in AZ • 2006 – 7th largest in the US • 2007 – 5th largest out of 71 programs • Kidney Transplant Program • 2007 – 22nd largest out of 245 programs overall • Living Donor Kidney Program (1999) • 2006 – 15th largest in the US • 2007 – 12th largest out of 245 programs • Laparoscopic Donor Procedure (1999) • First in the Foundation & Arizona • Pancreas Transplant Program • November 2002 UNOS Certified • First K/P Transplant in July 2003 • 2006 – 7th largest in the US • 2007 – 3rd largest not factoring pancreas alone

  5. MCA Liver Transplantation Program • 1999 to 2007 Volume Data • Liver Transplants - 411 • Living Donor Transplants - 77 (19%) • 2007 Volume Data • Liver Transplants - 66 • 13 of 66 Transplants - Living Donor • 2006 Outcome Data* • 1 Year Patient Survival • 91.85% Actual vs. 88.18% National Avg (Combined) • 1 Year Graft Survival • 89.41% Actual vs. 84.43% National Avg (Combined) * SRTR National Data Base - January 2007 Release

  6. Mayo System and National Comparison % 1 Year Patient and Graft Survival SRTR National Data Base - January 2007 Release Deceased Donor Only for Appropriate Comparison

  7. Mayo System and National ComparisonMedian Length of Stay Post Transplant SRTR National Data Base - January 2007 Release Median LOS for Deceased Donor

  8. Liver Waitlist & Transplants2001 - 2007 Wait List Size as of Last Day of Year

  9. Etiology of Liver Disease * Liver disease transplanted Q1 2007 Q1 2007

  10. Cold Ischemia Time (hours)Cumulative • Average CIT 5.95 hrs • MedianCIT5.75hrs • Range1.5 -23 hrs Q1 2007

  11. Benchmarking: National Centers of ExcellenceUNOS Patient Survival Data(1/01/04 - 6/30/06 w/ 1 Mo. & 1 Yr. Cohorts; 01/01/01 - 6/30/03 w/ 3 Yr. Cohort) Q4 2007

  12. Benchmarking: National Centers of ExcellenceUNOS Graft Survival Data(1/01/04 - 6/30/06 w/ 1 Mo. & 1 Yr. Cohorts; 7/01/01 – 12/31/03 w/ 3 Yr. Cohort) Q4 2007

  13. Kidney / Pancreas Transplant Program2007

  14. MCA Kidney Transplantation Program • 1999 to 2007 Volume Data • Kidney Transplants - 890 • Living Donor Kidney Transplants - 455 (51%) • Pancreas Transplants - 70 • 2007 Volume Data • Kidney Transplants - 185 • Living Donor Kidney Transplants - 88 (51%) • Pancreas Transplants - 30 • 2006 Outcome Data Kidney Transplant* • 1 Year Patient Survival • 96.13% Actual vs. 96.47% Expected • 1 Year Graft Survival • 92.83% Actual vs. 93.34% Expected * SRTR National Data Base - January 2007 Release Combined Living and Deceased Donor Transplants

  15. Mayo System and National Comparison % 1 Year Patient and Graft Survival * SRTR National Data Base - January 2007 Release Combined Living and Deceased Donor Transplants

  16. Mayo System and National ComparisonLength of Stay - Time on Wait List SRTR National Data Base - January 2007 Release LOS for Deceased Donor, Wait Times Includes Both Living and Deceased Donor Transplants

  17. Kidney Waitlist & Transplants2001 - 2007 Wait List Size as of Last Day of Year

  18. Donor Source (N=654)Cumulative Living Related Donor 238 Living Unrelated Donor 154 Deceased Donor 262 Q1 2007

  19. Pancreas Transplantation at MCA

  20. Pancreas Transplants at MCA by type of transplant

  21. Type of Surgical Procedure

  22. MCH Patient/Graft Survival for KP Txs (Kaplan-Meier)

  23. MCH Patient/Graft Survivalfor PAK & PTA (Kaplan-Meier)

  24. Thymoglobulin Prograf MMF Long-term steroids Campath Prograf MMF Rapid steroid taper Immunosuppression

  25. Acute Rejection during the first year • Kidney-Pancreas : 17% • Solitary Pancreas: 32%

  26. Kidney-Pancreas : Steroid Avoidance • 37 patients • Patient survival 100% • Graft Survival • Kidney 97% • Pancreas 95% • Acute Rejection 11%

  27. Pancreas Experience with HTK(n=100) • Mean CIT = 9.6hrs (4hrs – 22.9hrs) • Less than 12hrs – 77% • 12 to 15.9hrs – 18% • Greater than 16hrs – 5% • No cases of graft pancreatitis or vascular thrombosis due to preservation

  28. Historical Total Transplant Volumes 2001 to present

  29. Conclusions • Strong clinical academic solid organ transplant practice with complete conversion from UW to Custodial HTK in 2003 without any negative effect • Improved outcomes using Custodial for Living Donor Liver Transplantation • Recommendation for HTK for DCD donors to improve outcomes

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